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ACLS

Advanced Cardiac Life Support

Pre-Test

Unresponsive victims should receive


CPR.

TRUE or FALSE?

Chain of Survival

Can I get AIDS from doing


CPR?

Lets hope not


There has never been a documented
case of AIDS transmitted by CPR.

*10.1016/j.resuscitation.2005.09
.016

Is it safe to perform CPR in


patient with present heart beat?

YES
It is not dangerous to perform chest
compressions even if the heart is
still
beating. You cannot make a patient
any worse than he or she already is.

*Circulation. 2007;116:e566-e568

Will CPR always save a


life?

NO
In fact, most instances of
CPR for cardiac arrest are
unsuccessful.

Can I kill someone if I do CPR


incorrectly?

NO
Remember, the person in cardiac
arrest is already clinically
dead. CPR can only help.

The following are signals of a heart


attack:
A.
B.

Sudden and persistent chest pain or discomfort

Breathing difficulty

C. Nausea or vomiting
D. Pale or bluish skin color, moist or sweaty skin
E. All of the above

The main dish of VF is defibrillation?

TRUE or FALSE?

After witnessing sudden cardiac


arrest, which number do you tap in
your cellphone?
A. 118
B. 0274-420118
C. 0274-587333
D. 08157936xxx
E. 08195521xxx

Overview ACLS
A kind of training for physician
Established by AHA, in Indonesia by PERKI
Rarely taught in medical school

Materials
BLS
Cardiac Arrest
Tachycardia
Bradycardia
Acute Coronary Syndrome (ACS)
Hypotension, shock, acute pulmonary
edema
Drugs in ACLS
Defibrillation principles

Science overview

Good ACLS begins with Good


BLS

BLS Algorithm 2005

BLS Algortihm 2010

ACLS 2005

ACLS 2010

DEFIBRILLATION

Backgrounds
Why so important?
The leading cause of cardiac arrest is
ventricular fibrillation (VF)
The most effective treatment for VF is
defibrillation
Every 1 minute delay will drop the succesful
rate as much as 10%

Early Defibrillation
Concept
What happen in VF and pulseless VT?
Heart stops beating no circulation
oxygen will depleted in less than 90
seconds
Myocardial Ischemia cell energy
depleted

Early Defibrillation
Concept

If defibrillation is performed when


myocardial energy is depleted, the chance
of myocardium can contract after asystole
period is very little

Technical concept

What is defibrillator?
A device that can produce controlled Direct
Current Shock

How does it works?


It is simple, it SHUT DOWN and RESTART the
heart

Indication
VF, Pulseless VT defibrillation
Other tachyarrythmia : VT, VT torsade de
pointes, atrial flutter, atrial fibrillation,
supraventricular tachycardia
synchronized cardioversion

Biphasic vs Monophasic
Biphasic is more advantageous
The energy needed is lower
Prevent myocardial damage

Paddles
Sternal paddle:
right parasternal
below the right
clavicle
Apex paddle:
in the apex, left
mid axillar

TATA LAKSANA
DEFIBRILASI

Letakkan penderita pada posisi aman di


tempat yang teduh dan kering dan sirkulasi
udara yang baik. Bila dada penderita basah,
sebaiknya keringkan dulu.

Operator dan peralatan normalnya di sisi


kiri penderita

Nyalakan defibrillator agar dalam kondisi


siap, tentukan energi yang diberikan

Beri jelly yang cukup banyak pada paddle,


kemudian ratakan pada kedua paddle.
cukup banyak untuk menutupi kedua
permukaan paddle, tapi tidak boleh
berlebihan, supaya tidak terjadi hubungan
pendek

Lakukan pengisian defibrillator (charge)

Tempelkan kedua paddle sesuai tempatnya


masing-masing. Beri tekanan sekitar 25
pound (12 kg) secara mantap. Pastikan
permukaan paddle menempel dengan baik
pada dinding dada tanpa ada rongga
diantaranya

Pastikan irama jantung penderita adalah


irama VF atau VT tanpa pulsasi

Sebelum melakukan shock berikan aba-aba


pada seluruh anggota tim untuk tidak
bersentuhan dengan pasien maupun
tempat tidurnya sambil memastikan diri
sendiri juga tidak bersentuhan. Contoh abaaba:
- Im going to shock on three
- One, Im clear
- Two, you are clear
- Three, everybody clear
Lihat lagi apakah semua sudah aman

Lihat monitor untuk memastikan irama


belum berubah

Segera tekan tombol discharge secara


bersamaan untuk melepaskan energi listrik
ke pasien, sambil tetap menekan paddle
dengan mantap ke dinding dada pasien

Segera angkat paddle lanjut RJP 5 siklus


nilai ulang irama jantung

The End
Wassalamualaykum warrohmatullohi wabarokatuh

Lets go back there,


we miss those
place, dont we?